Pharmacologic approaches to sedation, pain relief and neuromuscular blockade in the intensive care unit. Part III: Neuromuscular blockade

摘要

Neuromuscular blockade is frequently required to facilitate tracheal intubation and mechanical ventilation in critically ill patients. Because neuromuscular blocking agents ablate ventilation as well as protective reflexes, special precautions are necessary. Risk-reduction strategies include the use of train-of-four or other monitors of the depth of neuromuscular blockade, and processed electroencephalographic monitoring to ensure adequate sedation (discussed in detail in Part I of this series in Clinical Intensive Care, 14(1/2)). Neuromuscular blocking drugs may be characterized as depolarizing or non-depolarizing, and by their chemical structures. Onset and duration of action, clinical effects, and routes of drug disposition vary. These factors, along with cost, help determine the preferred agents for neuromuscular blockade in critically ill patients with and without organ system failure.